Provider Demographics
NPI:1073968509
Name:TAUBE FAMILY DENTAL
Entity Type:Organization
Organization Name:TAUBE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUBE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-566-7384
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:PO BOX 142
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-2135
Mailing Address - Country:US
Mailing Address - Phone:618-566-7384
Mailing Address - Fax:618-566-4290
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-2135
Practice Address - Country:US
Practice Address - Phone:618-566-7384
Practice Address - Fax:618-566-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029166122300000X
IL019022047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty